Correlation between laboratory coagulation testing and thromboelastometry is modified during management of trauma patients.

Background: Thromboelastometry (ROTEM(R)) is increasingly being used to make a diagnosis of coagulopathy and to guide hemostatic therapy (HT). Although ROTEM(R) parameters and standard laboratory test (SLT) correlated well before administration of HT, it is not known if this correlation persists after hemostatic resuscitation. Methods: A retrospective analysis of prospectively collected data from a trauma registry (2011-2014) was performed. All patients having a ROTEM(R) analysis were included. ROTEM(R) parameters (clotting time, CT and clot amplitude at 5 min, A5) were determined after activation with tissue factor (EXTEM) or platelet inhibition with cytochalasine D (FIBTEM). Spearman's rank correlation coefficient was calculated for the correlation between SLT and thromboelastometry parameters and thresholds were determined with ROC curve analysis for the diagnosis of an INR > 1.5, a fibrinogen 24 (r= 0.465). As well, for the diagnosis of increased INR, sensitivity and the area under the ROC curve decreased from 75% and 0.894 (no treatment) to 20% and 0.653 (fibrinogen concentrate). Areas under the ROC curve for the prediction of a fibrinogen or platelet decrease were not significantly altered regardless of the treatment group. Conclusions: A decreased of the correlation between standard laboratory tests and ROTEM(R) parameters, was observed at admission or during care, which could be in relation with injury severity, base deficit or the administration of blood products, particularly fibrinogen concentrate. Further work will be necessary to better understand which tool is the most suitable for guiding hemostatic therapy. Level of Evidence: Diagnostic study, level III. (C) 2016 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader http://ift.tt/1U0KmQm